Shots - Health Blog

9:52 am

Tue December 20, 2011

Hospitals That Serve The Poor Struggle With Readmissions

Hospitals across the country are trying to clamp down on frequent readmissions in anticipation of new penalties Medicare is readying. But it's a bigger problem at hospitals that treat lots of low-income patients.

Poorer folks are more likely to be readmitted, so hospitals that treat a lot of them face special challenges at the same time those hospitals often have fewer resources, researchers have found.

Indeed, places that have the highest proportion of poor patients are nearly three times as likely to have high heart readmission rates, according to a Kaiser Health News analysis. That's the case with New York-Presbyterian Hospital in Manhattan, Howard University Hospital in Washington and Johns Hopkins Bayview Medical Center in Baltimore. (KHN has an interactive chart where you can look up hospitals in your region to see their heart failure readmission rate and the poverty level of their patients).

The problem may be even bigger. An analysis published this month in the New England Journal of Medicine showed that the places with the most readmissions also tended to have the most initial hospital admissions.

The implication: health care providers in some places are more prone to direct patients into the hospitals than are doctors elsewhere. Changing that behavior, the researchers write, will require changing the way doctors and hospitals are paid — something Medicare is trying through so-called accountable care organizations and bundled payments.

But hospitals are creatures of their environment. "The failure of care may not be at the hospital level," says Karen Joynt, a researcher and cardiologist at Brigham and Women's Hospital in Boston. "The failure of care may be in the community or with the patient or the system."

Some hospitals have opened specialized clinics that help newly discharged patients with serious medical conditions or those who lack insurance or a primary care physician.

In addition, some doctors are also opening clinics that focus on reducing hospital readmissions. HealthCare Partners Medical Group, a large multispecialty physician group based in Torrance, Calif., is one.

In the past three years, the group has opened five Comprehensive Care Centers in Southern California that cater to patients who have just left the hospital or who have serious, often chronic, medical conditions, similar to those targeted by hospital post-discharge clinics.

The medical group has its own financial reasons for making sure patients stay out of the hospital and don't receive unnecessary care: Instead of the typical fee-for-service arrangement in which physicians receive payments a la carte for services they provide, HealthCare Partners operates much like an ACO and shoulders the financial risk for managing members' health.

"Because of that model, we're very interested in making sure our members don't have avoidable hospitalizations or emergency room visits, especially in that time after discharge," says Dr. Tyler Jung, medical director for high-risk and hospital programs.